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Observation Time Frame?

  1. Default Observation Time Frame?
    Medical Coding Books
    I am coding a hospital charge and the hospital's facesheet states patient admitted on 05/10 as observation status until 05/13, Isn't that more than allowed? I thought it was 48hrs until considered inpatient? My doctor is the admitting dr. and patient has Medicare so I coded it 99218 for admit w/AI, then day two I did 99219 for level 2, day three I did 99218 for level one and for discharge I did 99217. It states observation is for e and m of patient per day so is this appropriate? Thanks,Gail

  2. #2
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    Quote Originally Posted by thomasgail View Post
    I am coding a hospital charge and the hospital's facesheet states patient admitted on 05/10 as observation status until 05/13, Isn't that more than allowed? I thought it was 48hrs until considered inpatient? My doctor is the admitting dr. and patient has Medicare so I coded it 99218 for admit w/AI, then day two I did 99219 for level 2, day three I did 99218 for level one and for discharge I did 99217. It states observation is for e and m of patient per day so is this appropriate? Thanks,Gail
    In the rare circumstance when a patient receives observation services for more than 2 calendar dates, the physician shall bill a visit furnished before the discharge date using the outpatient/office visit codes. The physician may not use the subsequent hospital care codes since the patient is not an inpatient of the hospital.

    http://www.cms.gov/manuals/downloads/clm104c12.pdf

    (Page 46)

    So...in your case, it would look something like this (example only)-

    Day 1=99218
    Day 2=99212-99215
    Day 3=discharge 99217

    .

  3. Default
    I didn't realize we could code both outpt/office and observation together, I thought I would have to bill each day with an observation code. I will give it a try, thank you!

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